本文關(guān)鍵詞：中國成人肥胖十年變化及對死亡影響的研究　出處：《中國疾病預(yù)防控制中心》2017年博士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 肥胖 社會經(jīng)濟地位 死亡 中國成人 趨勢

【摘要】：研究背景與目的2013全球疾病負擔研究表明高BMI造成了440萬人死亡。肥胖不僅是一種獨立的疾病和多種慢性病的重要危險因素,還會引發(fā)健康不公平,已成為世界各國最為關(guān)切的綜合性社會問題之一。本研究采用系統(tǒng)和綜合評價指標,全面分析2002～2012年我國人群肥胖流行狀況、肥胖不平等程度及變化趨勢;探討肥胖與死亡的關(guān)系;為我國制訂肥胖防控策略,有的放矢地開展人群肥胖干預(yù),提高人群期望壽命與促進健康公平提供理論依據(jù)和支撐。研究內(nèi)容與方法利用最具國家代表性、人群及地區(qū)特征的2002和2012年中國居民營養(yǎng)與健康狀況調(diào)查數(shù)據(jù),對141141和119694名18歲及以上調(diào)查對象的信息進行分析,內(nèi)容包括問卷調(diào)查法收集的人口學(xué)基本特征、吸煙、飲酒等信息;采用標準方法和統(tǒng)一型號的器材測量的身高、體重、腰圍,并計算體質(zhì)指數(shù)(BMI)、腰圍身高比(WHtR);空腹靜脈血檢測得到的血清甘油三酯等生化指標。依據(jù)中華人民共和國衛(wèi)生行業(yè)標準《成人體重判定》判斷全身性肥胖(24kg/m2≤BMI≤28kg/m2為超重,BMI≥28kg/m2為肥胖)和中心型肥胖(男性腰圍≥90cm;女性≥85cm);以WHtR≥0.50判定腰圍身高比超標;依據(jù)美國國家膽固醇教育計劃ATPIII亞洲人標準判定高甘油三酯腰圍表型(HTGW)。計算不同亞組中國成人體重、腰圍和BMI均值和標準誤;全身性肥胖、中心型肥胖、WHtR≥0.50、HTGW流行率和95%置信區(qū)間,及其絕對和相對變化。采用國際公認的方法,計算率比和不平等相對指數(shù)評價社會經(jīng)濟地位相關(guān)的肥胖不平等程度。對2012年數(shù)據(jù)采用復(fù)雜抽樣加權(quán)處理,所有數(shù)據(jù)采用2009年國家統(tǒng)計局公布的人口數(shù)據(jù)進行標化。兩個年代數(shù)據(jù)的絕對變化比較采用合并t檢驗。以2002年中國居民營養(yǎng)與健康狀況調(diào)查山西省數(shù)據(jù)為基線,于2015年12月至2016年3月對研究對象進行死因回顧調(diào)查及隨訪,其中年齡、性別、身高、體重、腰圍等基線信息完整者7007人,隨訪到5360人,隨訪率為76.5%。將研究對象按BMI、腰圍和WHtR分別分為8組,計算分組死亡率,以最低組作為參照,采用Cox比例風險回歸模型估計全人群、分性別、年齡(≥60歲、60歲)的各組死亡相對風險及95%置信區(qū)間,模型調(diào)整基線年齡、性別、吸煙、飲酒、文化程度等因素。通過剔除現(xiàn)在吸煙者、意外原因死亡者、隨訪第一年內(nèi)死亡者,隨訪時間不滿3年者進行敏感性分析。所有數(shù)據(jù)采用SAS 9.3軟件進行清理與統(tǒng)計分析,雙側(cè)檢驗,顯著性水平為P0.05。研究結(jié)果1.2002～2012年,我國成年男性體重、腰圍和BMI均值分別增長2.1 kg、2.7 cm和0.6 kg/m2;成年女性分別增長1.1 kg、2.1 cm和0.3 kg/m2。發(fā)現(xiàn)60歲以上的城市男性和50歲以上的城市女性三項指標有不同程度的下降。農(nóng)村居民三項指標的增幅是城市居民的3倍以上,三項指標的增幅為腰圍體重BMI。2.2012年,中國成人超重率、肥胖率、中心型肥胖率、WHtR≥0.5流行率和HTGW流行率分別為30.0%、11.8%、25.7%、48.4%和13.1%。與2002年相比,各型肥胖呈明顯上升趨勢,中心型肥胖增長快于全身性肥胖。農(nóng)村居民各型肥胖增速高于城市;18～49歲人群各型肥胖增長高于其他年齡組,60歲及以上老年人的全身性肥胖率基本穩(wěn)定,城市女性的全身性肥胖率出現(xiàn)下降。3.社會經(jīng)濟地位與肥胖的關(guān)系存在明顯性別差異。男性社會經(jīng)濟地位越高,體重、腰圍和BMI均值及各型肥胖率越高;女性則相反。十年間,低文化、低收入和以體力勞動為主的人群中各型肥胖率上升幅度最大;社會經(jīng)濟地位相關(guān)的肥胖不平等程度在男性有所縮小,女性則在擴大,低文化和低收入女性更容易受到肥胖危害。4.研究共隨訪94606.4人年,平均隨訪12.7年,死亡615人,隊列總死亡率為650.0/10萬人年。以BMI 26.0-27.9 kg/m2組為參照,調(diào)整多因素后,BMI18.5、18.5-19.9、22.0-23.9 和≥30.0kg/m2組的死亡風險明顯升高,RR值和95%CI分別為1.90(1.26-2.86)、1.68(1.15-2.45)、1.49(1.08-2.06)和 1.72(1.07-2.76)。以 90 cm≤男性腰圍95 cm,85 cm≤女性90 cm為參照,多因素(包括BMI)調(diào)整后,男性腰圍≥100 cm和女性≥95 cm組的死亡風險明顯升高,為1.85(1.11-3.08)。WHtR各組的死亡風險與參照組(0.47-0.49)相比,差異無統(tǒng)計學(xué)意義。對于60歲及以上老年人,低體重(BMI18.5kg/m2)和高腰圍(男性≥100cm和女性≥95 cm)組的死亡風險明顯升高,分別為1.94(1.20-3.15)和 2.07(1.08-3.96)。結(jié)論2002～2012年,我國人群各型肥胖率持續(xù)增長,不同亞組人群的流行特征存在明顯差異。農(nóng)村人群,特別是農(nóng)村男性,以及低社會經(jīng)濟地位人群應(yīng)作為肥胖防控的重點人群;同時應(yīng)重視老年人低體重營養(yǎng)不良造成的高死亡風險。我國人群中心型肥胖增長更為顯著,腰圍具有獨立于BMI的死亡預(yù)測作用,應(yīng)將腰圍作為與BMI同等重要的肥胖簡易快速篩查指標和死亡風險預(yù)測指標,在人群中推廣應(yīng)用。應(yīng)將人人保持健康體重作為重要的公共衛(wèi)生策略,并實施多層次的健康體重及社會決定因素干預(yù)活動,以防控慢性病、降低早死,促進健康公平。
[Abstract]:Background and objective 2013 of the global burden of disease study showed that high BMI caused 4 million 400 thousand deaths. Obesity is not only an important risk independent of disease and chronic disease factors, but also lead to the inequity of health, has become the world's most comprehensive social concern one. This study used and the comprehensive evaluation index system from 2002 to 2012, a comprehensive analysis of China's population prevalence of obesity, obesity and inequality trends; on obesity and mortality; obesity prevention and control strategy of making our country, to carry out targeted obesity intervention, improve life expectancy and promote health equity and provide a theoretical basis and support. The research contents and methods using the most on behalf of the state, characteristics of population and regions in 2002 and 2012 Chinese nutrition and health survey data of 141141 and 119694 subjects aged 18 years and above The analysis of information, including the basic demographic characteristics, collect the questionnaire on smoking, drinking and other information; using standard method and unified model of the equipment measured height, weight, waist circumference, and body mass index (BMI), waist to height ratio (WHtR); serum biochemical indicators such as blood get empty stomach.. on the basis of the People's Republic of China health industry standard adult weight determination > < judgment of systemic obesity (24kg/m2 = BMI = 28kg/m2 BMI = 28kg/m2 for overweight, obesity and central obesity (male) waist is larger than 90cm; women aged 85CM; WHtR = 0.50) to determine the waist height ratio exceed the standard; according to the National Cholesterol Education Program ATPIII Asian standard high triglyceride waist phenotype (HTGW). Calculation of different subgroups Chinese adult body weight, waist circumference and BMI mean and standard error; general obesity, central obesity, WHtR = 0.50, HTGW The rate and the 95% confidence interval, and the absolute and relative changes. Using internationally accepted methods of calculating rate and relative index of inequity evaluation of socioeconomic status related to obesity inequality. On the 2012 data using complex sample weighting, all data were standardized using the population data of National Bureau of Statistics announced in 2009 two years. The data were compared using t test with absolute change in 2002. Chinese nutrition and health survey data of Shanxi Province as the baseline, from December 2015 to March 2016 retrospective survey and follow-up, the object of study including age, gender, height, weight, waist circumference and other baseline information to complete the 7007 people, up to 5360 people, the rate of follow-up the study by 76.5%. BMI, waist circumference and WHtR were divided into 8 groups, with the lowest mortality rate calculation group, as the reference group, using Cox proportional hazards regression model to estimate the total Population, gender, age (over 60 years old, 60 years old) were the relative risk of death and 95% confidence interval, the models adjusted for baseline age, sex, smoking, alcohol consumption, factors of education. By eliminating the current smokers, accidental causes of death, death within the first year of follow-up, follow-up time of less than 3 years. Sensitivity analysis. All the data cleaning and statistical analysis using SAS 9.3 software, two-sided test, significant level P0.05. results from 1.2002 to 2012, China's adult male body weight, waist circumference and average BMI growth of 2.1 kg respectively, 2.7 cm and 0.6 kg/m2; the adult female growth of 1.1 kg respectively, 2.1 cm and 0.3 kg/m2. three indicators over the age of 60 men over the age of 50 city and city women have different degrees of decline. The three indicators of rural residents in city residents is more than 3 times, the three indicators of growth for waist weight BMI.2.2012, in The rate of adult overweight, obesity, central obesity rate, WHtR more than 0.5 prevalence rate and HTGW prevalence rates were 30%, 11.8%, 25.7%, 48.4% and 13.1%. compared with 2002, the obesity was significantly increased, central obesity is growing faster than overall obesity. Rural residents of various types of fat growth rate is higher than the City 18 to 49 year olds; the obesity growth higher than other age groups, the body fat of people aged 60 years and over rate basically stable, city women's obesity rate declined.3. relationship between socioeconomic status and obesity obvious gender differences. The higher socioeconomic status of male body weight, waist circumference and BMI the mean and the obesity rate is high; women are the opposite. In ten years, low culture, low income and with physical labor among the obesity rate of the largest increase; socioeconomic status is related to obesity inequality has narrowed in men, Women in the expansion, low culture and low income women are more susceptible to obesity hazards.4. study were followed up for 94606.4 years. The average follow-up of 12.7 years, 615 people died, the total mortality rate was 650.0/10 million years. The queue in BMI 26.0-27.9 kg/m2 group, after adjusting, BMI18.5,18.5-19.9,22.0-23.9 and more than 30.0kg/m2 group obviously the risk of death increased value of RR and 95%CI were 1.90 (1.26-2.86), 1.68 (1.15-2.45), 1.49 (1.08-2.06) and 1.72 (1.07-2.76). In 90 cm male waistline 95 cm, 85 cm less than 90 female cm as reference, many factors (including BMI) after adjustment, the risk of death for male and female waist circumference greater than 100 cm more than 95 cm was significantly elevated in group 1.85 (1.11-3.08).WHtR was the risk of death (0.47-0.49) compared with the reference group, the difference was not statistically significant. For the elderly aged 60 and above, low birth weight (BMI18.5kg/m2) and high waist circumference (male and female was 100cm = 95 cm) The risk of death was significantly elevated in group were 1.94 (1.20-3.15) and 2.07 (1.08-3.96). Conclusion: 2002 ~ 2012, the obesity rate of the population of our country continues to grow, there exist obvious differences in the epidemic characteristics of different subgroups. The rural population, especially the rural male, and low socioeconomic status groups should be the focus of obese people at the same time, should pay attention to prevention and control; elderly low weight malnutrition caused by high risk of death. China's population growth is more significant in central obesity, waist circumference is independent of the death of the BMI predictor should be equally important as waist circumference and BMI index and simple obesity screening death risk prediction index, application in the crowd we should all keep a healthy weight as an important public health strategy, and the implementation of a healthy weight and the multi-level social determinants of interventions to prevent chronic disease, reduce premature death, promote health Kang fair.

【學(xué)位授予單位】：中國疾病預(yù)防控制中心
【學(xué)位級別】：博士
【學(xué)位授予年份】：2017
【分類號】：R589.2

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